COVID-19 BUSINESS RESOURCES (SPONSORED)
On March 27, 2020, President Trump signed into law the Coronavirus Aid, Relief, and Economic Security Act, also known as the CARES Act (the “Act”). The purpose of the Act is to address the numerous areas impacted by the COVID-19 pandemic, including public health, business, economic, and others. This article discusses major impacts of the Act on health care providers and suppliers.
Health Insurer Reimbursement of COVID-19 Services
The Act modified the Families First Coronavirus Response Act (“FFCRA”) to increase access to care during the COVID-19 pandemic. Health insurance plans covering diagnostic tests are required under the Act to reimburse a provider either at a rate negotiated with the provider or an amount equal to the cash price for the test listed on the provider’s public website. It is important to note that the Act requires providers of COVID-19 diagnostic tests to make their cash price for their tests available on their public websites.
Additionally, health insurance plans are required to cover the costs of any “qualifying coronavirus preventive services” without cost-sharing being imposed on the patients. “Qualifying coronavirus preventive services” are items, services, or immunizations that are intended to prevent or mitigate COVID-19 and are either an evidence-based item or service with an “A” or “B” rating, or an immunization that recommended by the Centers for Disease Control and Prevention.
Limitations on Liability
Congress has stepped into an area of traditional state law by limiting the liability of a health care professional for any harm caused by any act or omission while providing services under certain circumstances during the public health emergency. The limitation of liability applies if the professional is:
- Providing care or services as a volunteer;
- The act or omission occurs in the course of providing services in the capacity of a volunteer;
- The services are within and do not exceed the scope of his/her license under state law;
- The services were related to the diagnosis, prevention, or treatment of COVID-19 or the assessment or care of an actual or suspected case of COVID-19; and
- The professional was acting in good faith.
This limitation on liability does not apply if the professional acted with willful or criminal misconduct, gross negligence, reckless misconduct, or a conscious flagrant indifference to the rights or safety of the individual harmed or if he/she provided services while under the influence of alcohol or an intoxicating drug.
Additional Telehealth Modifications
The Act modifies a number of provisions related to telehealth services to increase access during this emergency period. Most of these changes have been made to increase access for Medicare and Medicaid beneficiaries. One interesting change not directly related to reimbursement is the modification to the Internal Revenue Code’s (the “IRC”) deductions for Health Savings Accounts (“HSAs”). 26 U.S.C. 223. Under the IRC, individual taxpayers are eligible for an itemized deduction for payments to HSAs. For eligibility, an individual must be covered by a high- deductible health plan, which is a plan with an annual minimum deductible of $1,000 for an individual or $2,000 for a family, and the sum of the annual deductible and other out-of-pocket expenses of not more than $5,000 for an individual and $10,000 for a family. The modification creates a safe harbor so that plans charging no deductible for telehealth and other remote care services can still qualify as a high-deductible health plan and individuals can remain eligible for the deduction for contributions to HSAs.
The Act also makes important changes to the use of telehealth for certain home care services. Prior requirements for patients receiving home dialysis treatment required a physician to complete an in-person clinical assessment monthly during the initial three month period and then once during each subsequent three month period. These restrictions have been temporarily suspended to permit the monthly assessments to be done through a telehealth service.
Modifications to Home Health Services
The Act also makes important changes to the normal provision of home health services. One important change is the expansion of the scope of nurse practitioners, clinical nurse specialists, and physician’s assistants in the provision of home health services, from the date of enactment of the Act to a period set by the Secretary no more than six months from enactment. Nurse practitioners, clinical nurse specialists, and physician assistants will be permitted, during this period, to certify and recertify patients for home health services and review the patient’s plan of care. Additionally, while prior law required patients to be under the care of a physician, during the emergency period, beneficiaries can be under the care of nurse practitioners, clinical nurse specialists, and physician’s assistants and still qualify for services. Finally, during this period, nurse practitioners, clinical nurse specialists, and physician’s assistants may also prescribe covered osteoporosis drugs to be furnished by a home health agency. In order to qualify, nurse practitioners, clinical nurse specialists, and physician’s assistants must be licensed and acting within the scope of State law and must be enrolled as Medicare providers. This expansion also applies to Medicaid covered home health services.
The Act has included the “COVID-19 vaccine and its administration” in the definition of “Medical and other health services” under Medicare Part B. Additionally, the COVID-19 vaccine and its administration have been excluded from the deductible beneficiaries are required to pay, so that beneficiaries would not be required to pay for these services.
Congress has also directed that Medicare Part D prescription drug plans or Medicare Advantage Prescription Drug Plan (“MA-PD”) permit enrollees to receive a three-month supply of their Part D covered medication unless there is an applicable safety edit assigned to that drug.
We hope you found the above key highlights on the changes implemented by the CARES Act of interest. These are uncertain times, and we are here to help you navigate through these changes.
Rose Willis is the chair of Dickinson Wright’s Health Care Law Group. She can be reached at 248.433.7584 or [email protected]
Jeremy Belanger is an Associate in Dickinson Wright’s Troy office. He can be reached at 248.433.7542 or [email protected]
Jessica Busch is an Associate in Dickinson Wright’s Troy office. She can be reached at 248.433.7221 or [email protected]
Erica Erman is an Associate in Dickinson Wright’s Phoenix office. She can be reached at 602.889.5342 or [email protected]